Provider Demographics
NPI:1801184205
Name:NIEMAN, JOLENE (DPT)
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:NIEMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JOLENE
Other - Middle Name:
Other - Last Name:BLUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:237 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TWIN LAKES
Practice Address - State:WI
Practice Address - Zip Code:53181-9681
Practice Address - Country:US
Practice Address - Phone:262-877-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-018451225100000X
WI17133-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6237009OtherMEDICARE
ILIL6238009OtherMEDICARE
ILIL6697015OtherMEDICARE
ILP01193482OtherRAIL ROAD MEDICARE NUMBER